Breakpoints #129 – Game of Spores: Blasto, Histo, Crypto, and Cocci
Jan 16, 2026
Dr. George R. Thompson, a UC Davis specialist in invasive fungal infections, and Dr. Gregory Eschenauer, an infectious diseases pharmacy expert from Michigan, explore Blastomyces, Histoplasma, Coccidioides, and Cryptococcus. They cover epidemiology, diagnostics, clinical presentations, and nuanced antifungal therapy debates. Expect practical talk on testing limits, amphotericin strategies, itraconazole formulation and monitoring, and transplant prophylaxis controversies.
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Endemic Fungi Ecology And Shifting Maps
- Endemic dimorphic fungi live as molds in the environment and convert to yeast at body temperature, making inhalation of spores the usual portal of entry.
- Geographic maps of endemicity are imperfect and likely expanding due to travel and climate change.
Think Endemics For Severe Respiratory Cases
- Consider endemic fungal infections in the differential for severe respiratory illness even in immunocompetent hosts, especially with regional exposures.
- Empiric amphotericin may be warranted for suspected blastomycosis ARDS while pursuing diagnostics.
Cryptococcus Species Differ By Host And Habitat
- Cryptococcus neoformans is globally ubiquitous and favors CNS disease, especially in advanced HIV and other immunosuppression.
- Cryptococcus gattii more often infects immunocompetent hosts and links to trees rather than bird droppings.